Mutch W A, Harms S, Ruth Graham M, Kowalski S E, Girling L G, Lefevre G R
Department of Anaesthesia and Neuroanaesthesia Research Laboratory, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Respir Crit Care Med. 2000 Jul;162(1):319-23. doi: 10.1164/ajrccm.162.1.9903120.
Biologically variable mechanical ventilation (Vbv)-using a computer-controller to mimic the normal variability in spontaneous breathing-improves gas exchange in a model of severe lung injury (Lefevre, G. R., S. E. Kowalski, L. G. Girling, D. B. Thiessen, W. A. C. Mutch. Am. J. Respir. Crit. Care Med. 1996;154:1567-1572). Improved oxygenation with Vbv, in the face of alveolar collapse, is thought to be due to net volume recruitment secondary to the variability or increased noise in the peak inspiratory airway pressures (Ppaw). Biologically variable noise can be modeled as an inverse power law frequency distribution (y approximately 1/f(a)) (West, B. J., M. Shlesinger. Am. Sci. 1990;78:40-45). In a porcine model of atelectasis-right lung collapse with one-lung ventilation-we studied if Vbv (n = 7) better reinflates the collapsed lung compared with conventional monotonously regular control mode ventilation (Vc; n = 7) over a 5-h period. We also investigated the influence of sigh breaths with Vc (Vs; n = 8) with this model. Reinflation of the collapsed lung was significantly enhanced with Vbv-greater Pa(O(2)) (502 +/- 40 mm Hg with Vbv versus 381 +/- 40 mm Hg with Vc at 5 h; and 309 +/- 79 mm Hg with Vs; mean +/- SD), lower Pa(CO(2)) (35 +/- 4 mm Hg versus 48 +/- 8 mm Hg and 50 +/- 8 mm Hg), lower shunt fraction (9.7 +/- 2.7% versus 14.6 +/- 2.0% and 22.9 +/- 6.0%), and higher respiratory system compliance (Crs) (1.15 +/- 0.15 ml/cm H(2)O/kg versus 0.79 +/- 0.19 ml/cm H(2)O/kg and 0.77 +/- 0.13 ml/cm H(2)O/kg)-at lower mean Ppaw (15.7 +/- 1.4 cm H(2)O versus 18.8 +/- 2.3 cm H(2)O and 18.9 +/- 2.8 cm H(2)O). Vbv resulted in an 11% increase in measured tidal volume (VT(m)) over that seen with Vc by 5 h (14.7 +/- 1.2 ml/kg versus 13. 2 ml/kg). The respiratory rate variability programmed for Vbv demonstrated an inverse power law frequency distribution ( y approximately 1/f(a)) with a = 1.6 +/- 0.3. These findings provide strong support for the theoretical model of noisy end-inspiratory pressure better recruiting atelectatic lung. Our results suggest that using natural biologically variable noise has enhanced the performance of a mechanical ventilator in control mode.
